Impedance Cardiography Case Study

G4 P3003 (4 Gestations, 3 Full Term, 0 Preterm, 0 Miscarriages, 3 Currently Living); 3 Spontaneous Vaginal Deliveries; Last birth was 7 years ago by SVD, weighed 4000 grams; No previous obstetrical complications or morbidity; No past medical history; No past surgical history; No prior antenatal care

Kristie’s miraculous recovery and pregnancy can only be understood by explaining some of the suffering she has gone through. Recently, Kristie was diagnosed with Antiphospholipid

Marie is pale, weak, and anxious, but no longer disoriented. Her fundus is firm and is 1 cm above the umbilicus. She is receiving O2 per nasal cannula at 4 liters/minute and has an O2 saturation of 88%. Her vital signs are: BP 74/44, pulse 116 and respirations 26. Her bleeding has slowed considerably. The nurse asks the UAP to bathe Marie and change the bed linens.

It is our pleasure to see and provide FTS for Ms. Jennifer Mullins. She is a 19yo, G1 P0, with EDD by an 8-week 1-day ultrasound performed in your office giving an EDD of 12/25/17. Her past medical history is notable for morbid obesity with a prepregnancy BMI of 45. She takes prenatal vitamins, denies any surgical history, is normotensive with a normal urine dip here. This is her 1st pregnancy. Her social history is negative x3. Her family history is notable for breast cancer, HTN, diabetes in her maternal grandmother, and heart disease in her as well. She has having occasional nausea, vomiting, and heartburn and says that the Diclegis is not working at all and would like a different prescription.

During our initial assessment of Ms. K.R., the following vital signs were noted: blood pressure was 147/67, temp 36.6 degrees Celsius, pulse 80 beats per min., respiratory rate of 20, pulse ox 99% on room air, a pain score of 8 during contractions, and fetal heart tones had a baseline of 130 over the last two hours. Her labs showed 2+ protein in her urine but she denied any headaches, vision changes, right upper quadrant pain, and no DTRs or colonus were observed. Ms.K.R. seemed to be handling her labor well, with the exception of being in a lot of pain and unable to find a comfortable position.

Because her initial pregnancy was preterm based on PPROM, she would be a candidate for 17-OHP and this was discussed and would recommend that this start at around 16-18 weeks gestation. In addition, because of her prior history of cesarean deliveries as well as her HIV status the plan will be to undergo a repeat cesarean in this pregnancy at around 38 weeks gestation and she does have good dates. She does have a follow-up appointment in your office in 3-4 weeks.

She reported having a normal delivery, full term with no complications; developed normally. Major events: none. Nutrition history: fair. Social history: Currently lives with 2 children in her mother’s house, separated with ex-husband, who is in jail and plans to get a divorce.

Ms. Pedroso is a pleasant 36 years old, pregnant females. She became pregnant after a first in-vitro attempted. Currently, the patient is 25 weeks of gestation and has come to the clinic with a chief complaint of recurring heartburn, which she described as a flame-throwing sensation in the epigastric area, abdominal bloating, and a sour taste in the back of her mouth. Ms. Carrillo states noting her symptoms two weeks ago and verbalized the symptoms worsen after eating; particularly after a heavy meal and with certain foods. She describes her pain 8/10 on the pain scale. The patient denies any chest pain or shortness of breath. Ms. Pedroso only known health problem is primary hypertension.

Brittany is a 22yo, G2 P1001, who was seen for an ultrasound evaluation and FTS. The patient states that she has a history of hypothyroidism but believes that she was tested in this pregnancy and told that her values were normal. I do not have copies of that lab work but would recommend that this be followed as her pregnancy progresses. She also reportedly has some issues with anxiety and IBS but is stable not on medication. She has a previous cesarean delivery with her last delivery but is uncertain about a VBAC. Lastly, she states that her main issue in this pregnancy is that when she wakes up in the morning after sleeping her arms and hands are numb or asleep and this did not occur in her previous pregnancy.

Keia is a 31yo, G2 P0100, who is currently 9 weeks 6 days as dated by a 6-week scan that was off from her LMP. She has a history of an IUFD at 29 weeks. She reports that she had decreased fetal movement prior to coming in and there being no fetal heart tones on examination, but other than that there were no other significant precipitating events. She did have an increased risk for Down syndrome at 1:140 but per the old reports all of her analytes were within normal limits. At the time of delivery, the baby did appear to be appropriate weight and there were no obvious causes at the time of delivery. She reports that she had chromosomes performed after and the chromosomes were negative. She also thinks she had a full autopsy that was unremarkable. She did have a work-up for clotting disorders due to the history of loss and according to the chart everything is relatively within normal limits except for MTHFR which was heterozygous for C677T and A1298C. I did not see beta-2 glycoprotein or antithrombin III. Because of the relatively normal work-up she is on a baby aspirin and Metanx. She is here today to discuss her history and plans for this pregnancy.

She is without complaints. She has not noted any increase in preterm labor. No signs/symptoms or change in pelvic pressure. She is compliant with bedrest and has help taking care of her son. She is otherwise aware that she should discontinue Motrin next week and is aware of the signs/symptoms that we are monitoring. The placental cord insertion does appear marginal as noted on prior ultrasound and we are following monthly growth. She is aware that after surveillance of cervical length which will the last one we would anticipate would be next week at 32 weeks and after that we would still recommend monthly evaluation of fetal growth. Preterm labor precautions were reviewed. She is scheduled to return in one

Serrita is a 26yo, G3 P1011, who was seen for an ultrasound evaluation and fetal anatomy assessment. As you know, she has chronic HTN and is on methyldopa 500 mg b.i.d. Her BP is normal on today’s assessment at 130/78. Her urine evaluation was negative. She is also hypothyroid status-post a diagnosis of Hashimoto’s thyroiditis. She is on replacement therapy. She did undergo noninvasive prenatal testing (NIPT) that returned low-risk, female and her maternal serum AFP was normal at 0.58 MoM. Based on her height and weight at the start of the pregnancy, her BMI was about 38. Lastly, she is on metformin 500 mg b.i.d. She states that she believes that she was on this due to abnormal insulin levels but she was not completely certain as to why

It is our pleasure to see and perform FTS on Ms. Kaylyn Houser. She is a 16yo, G1 P0, with EDD by LMP consistent with an 8-week 4-day ultrasound performed in your office. The patient has a history of anxiety and what sounds like bipolar disorder, narcolepsy, and sleep apnea, as well as prepregnancy BMI of 32. She was previously on Lamictal, Luvox, and magnesium when she started the pregnancy and comes today attempting to wean from the Lamictal currently taking 100 mg daily. Her surgical history is notable for ankle surgeries. She has no prior pregnancy history. Her social history is negative x3. Her registration BP is 137/81. Her urine dip is negative for protein.

This particular case study involves a 29 year old obstetric patient who presented to the labor and delivery unit at 33 weeks gestation with complaints of abdominal pain for the past three days that had become more severe and absence of fetal movement noted since the previous evening. Her obstetric history revealed she has one living child and has had one previous miscarriage at ten weeks

Afton is a 31yo, primigravida, who is currently 23 weeks 6 days. She has type 2 diabetes but her A1C coming into pregnancy was just under 6. A recent A1C in June was 6.1. She is currently on insulin with Levemir and NovoLog. She also has chronic HTN and takes labetalol. She is on a baby aspirin for preeclampsia prevention. She has been following in our perinatal diabetes program and we have made some adjustments. Because of her type 2 diabetes she is here today for a fetal ECHO.